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Elkholy MM et al, 2015: Efficacy of extracorporeal shockwave lithotripsy using Dornier SII in different levels of ureteral stones.

Elkholy MM, Ismail H, Abdelkhalek MA, Badr MM, Elfeky MM
Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Abstract

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi.
PATIENTS AND METHODS: A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL). Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of ≤1 cm. The stones were not impacted, with normal kidney functions. Procedure time, number of shocks, energy used, number of sessions and complications were reported. The outcome of ESWL was also recorded. RESULTS: Stones were in the
abdominal (upper ureter) in 50% of patients, in pelvic (middle ureter) in 47% of patients. All patients had unilateral stones and the mean stone size in maximum length was) 10 mm). Good dye excretion passing the stone was noted in all patients. Mild hydronephrosis was found in 85% of cases. A total of 49 cases were treated by a single session, while in 35% of cases two sessions were enough and 16% received three sessions. The average number of shocks per session was 3125. The average number of shocks per patient was 5962.5 shocks and average energy was 204.3 Joules. The overall stone-free rate 3 months after lithotripsy was 94%. After a single session of lithotripsy, 49 patients (49%) became stone-free. Stone free rates after ESWL for upper, middle ureteral stones were 94%, 95.7% respectively. Additional procedures were needed in only 6 cases (6%) to render patients stone-free after lithotripsy. No serious complications occurred. CONCLUSION: The Dornier lithotripter S II is very effective in the treatment of ureteral calculi with no major
complications. 

Urol Ann. 2014 Oct;6(4):346-51. doi: 10.4103/0974-7796.141003.

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Comments 1

Hans-Göran Tiselius on Monday, 09 March 2015 09:28

With a stone-free rate of 94% the results of SWL (Dornier lithotripter SII) for ureteral stones are very good. It is, however, surprising that the number of sessions was as high as 2.3-2.6. It is stated that only 49% of the stones were satisfactorily disintegrated with only one session.

It is of note that distal ureteral stones obviously were excluded from this form of treatment.

It is not evident from the report whether the success was identified by ureters free of fragments or if patients with well disintegrated fragments still present in the ureter also were considered as successfully treated.

That 2 out of 100 patients treated for stones in the ureter developed perinephric/subcapsular hematoma is an unexpected outcome. But it was mentioned that the extent of these blood accumulations was small and obviously they did not cause clinical symptoms.

There was a high frequency (42%) of pain after treatment, but it is not clear if this high percentage of pain was recorded despite the statement that the patients regularly were given analgesics between SWL sessions.

With a stone-free rate of 94% the results of SWL (Dornier lithotripter SII) for ureteral stones are very good. It is, however, surprising that the number of sessions was as high as 2.3-2.6. It is stated that only 49% of the stones were satisfactorily disintegrated with only one session. It is of note that distal ureteral stones obviously were excluded from this form of treatment. It is not evident from the report whether the success was identified by ureters free of fragments or if patients with well disintegrated fragments still present in the ureter also were considered as successfully treated. That 2 out of 100 patients treated for stones in the ureter developed perinephric/subcapsular hematoma is an unexpected outcome. But it was mentioned that the extent of these blood accumulations was small and obviously they did not cause clinical symptoms. There was a high frequency (42%) of pain after treatment, but it is not clear if this high percentage of pain was recorded despite the statement that the patients regularly were given analgesics between SWL sessions.
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